Provider Demographics
NPI:1407058480
Name:HEARTPUMPER INCORPORATED
Entity Type:Organization
Organization Name:HEARTPUMPER INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, SR. CLINICAL PERFUSIONIST
Authorized Official - Prefix:PROF
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:RALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, CCT, CCP
Authorized Official - Phone:321-480-3008
Mailing Address - Street 1:5302 OUTLOOK DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-2345
Mailing Address - Country:US
Mailing Address - Phone:321-480-3008
Mailing Address - Fax:
Practice Address - Street 1:5302 OUTLOOK DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-2345
Practice Address - Country:US
Practice Address - Phone:321-480-3008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
173000000X
FL1744R1102X, 242T00000X, 246QH0401X, 246RP1900X, 246XC2901X, 2472B0301X, 2472V0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Not Answered1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Multi-Specialty
Not Answered242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionistGroup - Multi-Specialty
Not Answered246QH0401XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyHemapheresis PractitionerGroup - Multi-Specialty
Not Answered246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
Not Answered246XC2901XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularCardiovascular Invasive SpecialistGroup - Multi-Specialty
Not Answered2472B0301XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherBiomedical EngineeringGroup - Multi-Specialty
Not Answered2472V0600XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherVeterinaryGroup - Multi-Specialty